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Inflammatory bowel disease in India - Past, present and future

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ABSTRACT

There is rising incidence and prevalence of inflammatory bowel disease (IBD) in India topping the Southeast Asian (SEA) countries. The common genes implicated in disease pathogenesis in the West are not causal in Indian patients and the role of “hygiene hypothesis” is unclear. There appears to be a North-South divide with more ulcerative colitis (UC) in north and Crohn’s disease (CD) in south India. IBD in second generation Indian migrants to the West takes the early onset and more severe form of the West whereas it retains the nature of its country of origin in migrants to SEA countries. The clinical presentation is much like other SEA countries (similar age and sex profile, low positive family history and effect of smoking, roughly similar disease location, use of aminosalicylates for CD, low use of biologics and similar surgical rates) with some differences (higher incidence of inflammatory CD, lower perianal disease, higher use of aminosalicylates and azathioprine and lower current use of corticosteroids). UC presents more with extensive disease not paralleled in severity clinically or histologically, follows benign course with easy medical control and low incidence of fulminant disease, cancer, complications, and surgery. UC related colorectal cancer develop in an unpredictable manner with respect to disease duration and site questioning the validity of strict screening protocol. About a third of CD patients get antituberculosis drugs and a significant number presents with small intestinal bleed which is predominantly afflicted by aggressive inflammation. Biomarkers have inadequate diagnostic sensitivity and specificity for both. Pediatric IBD tends to be more severe than adult. Population based studies are needed to address the lacunae in epidemiology and definition of etiological factors. Newer biomarkers and advanced diagnostic techniques (in the field of gastrointestinal endoscopy, molecular pathology and genetics) needs to be developed for proper disease definition and treatment.

No MeSH data available.


Related in: MedlinePlus

Association of different genes with inflammatory bowel disease, ulcerative colitis and Crohn’s disease. Genes shown outside the Venn diagram were not associated. CD: Crohn’s disease; IBD: Inflammatory bowel disease; UC: Ulcerative colitis.
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Figure 1: Association of different genes with inflammatory bowel disease, ulcerative colitis and Crohn’s disease. Genes shown outside the Venn diagram were not associated. CD: Crohn’s disease; IBD: Inflammatory bowel disease; UC: Ulcerative colitis.

Mentions: Involvement of genes in the pathogenesis of a disease can be deciphered from the disease occurrence in family members, siblings and twins. The Indian IBD task force data showed positive family history of IBD in 2.9% cases only (UC 2.3% and CD 4.6%). In one study there was no association of HLA DR and DQ with CD[34]. Studies on causative role of individual genes have only started recently in India especially with the discovery of single nucleotide polymorphisms (SNP) of 163 genes associated with IBD (at various points of its immune mechanism) in Caucasian populations (of whom NOD2 gene shows the most definite association with disease phenotype). The association of different genes with IBD in India studied till now are shown in Figure 1[35-55]. Multiple studies have negated the association of NOD2 gene with CD in India[52-54] but SNP 268Pro/Ser increased relative risk of UC (OR = 1.72, 1.14-2.52)[51].


Inflammatory bowel disease in India - Past, present and future
Association of different genes with inflammatory bowel disease, ulcerative colitis and Crohn’s disease. Genes shown outside the Venn diagram were not associated. CD: Crohn’s disease; IBD: Inflammatory bowel disease; UC: Ulcerative colitis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037081&req=5

Figure 1: Association of different genes with inflammatory bowel disease, ulcerative colitis and Crohn’s disease. Genes shown outside the Venn diagram were not associated. CD: Crohn’s disease; IBD: Inflammatory bowel disease; UC: Ulcerative colitis.
Mentions: Involvement of genes in the pathogenesis of a disease can be deciphered from the disease occurrence in family members, siblings and twins. The Indian IBD task force data showed positive family history of IBD in 2.9% cases only (UC 2.3% and CD 4.6%). In one study there was no association of HLA DR and DQ with CD[34]. Studies on causative role of individual genes have only started recently in India especially with the discovery of single nucleotide polymorphisms (SNP) of 163 genes associated with IBD (at various points of its immune mechanism) in Caucasian populations (of whom NOD2 gene shows the most definite association with disease phenotype). The association of different genes with IBD in India studied till now are shown in Figure 1[35-55]. Multiple studies have negated the association of NOD2 gene with CD in India[52-54] but SNP 268Pro/Ser increased relative risk of UC (OR = 1.72, 1.14-2.52)[51].

View Article: PubMed Central - PubMed

ABSTRACT

There is rising incidence and prevalence of inflammatory bowel disease (IBD) in India topping the Southeast Asian (SEA) countries. The common genes implicated in disease pathogenesis in the West are not causal in Indian patients and the role of “hygiene hypothesis” is unclear. There appears to be a North-South divide with more ulcerative colitis (UC) in north and Crohn’s disease (CD) in south India. IBD in second generation Indian migrants to the West takes the early onset and more severe form of the West whereas it retains the nature of its country of origin in migrants to SEA countries. The clinical presentation is much like other SEA countries (similar age and sex profile, low positive family history and effect of smoking, roughly similar disease location, use of aminosalicylates for CD, low use of biologics and similar surgical rates) with some differences (higher incidence of inflammatory CD, lower perianal disease, higher use of aminosalicylates and azathioprine and lower current use of corticosteroids). UC presents more with extensive disease not paralleled in severity clinically or histologically, follows benign course with easy medical control and low incidence of fulminant disease, cancer, complications, and surgery. UC related colorectal cancer develop in an unpredictable manner with respect to disease duration and site questioning the validity of strict screening protocol. About a third of CD patients get antituberculosis drugs and a significant number presents with small intestinal bleed which is predominantly afflicted by aggressive inflammation. Biomarkers have inadequate diagnostic sensitivity and specificity for both. Pediatric IBD tends to be more severe than adult. Population based studies are needed to address the lacunae in epidemiology and definition of etiological factors. Newer biomarkers and advanced diagnostic techniques (in the field of gastrointestinal endoscopy, molecular pathology and genetics) needs to be developed for proper disease definition and treatment.

No MeSH data available.


Related in: MedlinePlus